It is, as David Cameron says, a time to pause, listen and reflect: reflect that for every granny starving and dehydrating on an NHS ward there is quite possibly a patient in a private hospital being pulled screaming into a cold shower. If it wasn’t already obvious that private provision is no panacea for public services, it should be to anyone who watched last week’s Panorama film about Winterbourne View, a care home for people with learning disabilities run by Teesdale-based Castlebeck Care. For £3,500 a week, taxpayers have been funding a regime every bit as horrible as the state-run institutions which private care homes have largely replaced. Covert filming shows residents being habitually hit, pulled along the floor, pinned down under a chair for long periods and in one case goaded by a tattooed thug into repeating a suicide attempt.
There is no graphic footage of maltreatment in Southern Cross’s care homes, but in their own way they, too, have provided a poor advertisement for privately provided healthcare. Built on the hugely profitable business of selling care places to councils, the company turns out to have been constructed as an engine of wealth-creation for the asset-strippers who formerly owned it and pawned its freeholds. Now that it can no longer afford the rent on the homes it once owned, the taxpayer is likely to end up bailing it out.
If I were Andrew Lansley I would be tempted to send out my minions in search of NHS scandals on the scale of that of Stafford Hospital — and quick, before poor standards in private care homes becomes the overwhelming story. He isn’t going to succeed in selling NHS reforms based on greater private provision if the public conceive that the only achievement of private provision in public healthcare is to provide the patients with a better quality of carpet to be dragged along.
For some conservatives, private provision has become as much a dogma as nationalisation ever was on the left. Yet just look at some of the results. How do you defend PFI hospitals where the taxpayer will be forced to make payments for 30 years into the future on a hospital which may then be completely redundant? What good has come from privatising the railways now that fares have soared and they are swallowing four times as much subsidy as in the last years of British Rail — and yet for most journeys the poor passenger has no more choice than before? How come our contracted-out bin collections in some areas are so poor that every winter now resembles the winter of discontent?
Private provision of public services often fails because the commissioning is so lousy. It isn’t enough to dispatch some service to a private company and hope that all will be well. Sending middle-ranking civil servants to negotiate with CEOs of private companies is asking for trouble — that is how we ended up with a PFI deal where an NHS Trust was stung because its 30-year catering contract mentioned toast but omitted the marmalade.
The record of Independent Sector Treatment Centres is no great advertisement for the proposed NHS reforms. Conceived under Tony Blair to bring down costs for routine procedures such as hernia operations, they saved depressingly little money because their contracts tended to guarantee them a minimum level of income regardless of how few operations they were performing.
The problem with private provision is that in so many cases bureaucrats remain the direct customer. It isn’t passengers but civil servants who decide who runs their local trains. There is going to be a similar problem with the NHS reforms. Putting 90 per cent of the NHS budget into the hands of GPs is all very well but as patients we won’t feel any more powerful so long as we are not allowed much more choice in whom we appoint as our GP.
The debate on public services reform has degenerated into a deafening slanging match between unreformed socialists who won’t countenance a single employee leaving the state payroll and dogmatic privatisers. But the matter of who owns the hospitals and the dustcarts should come a rather poor second compared with whether they actually get their knees sorted out and their bins emptied.
Public service reforms will only work if they are seen to put us, the users, in charge. Lousy care homes and hospitals, private or state-run, will not survive if residents, patients and their families can vote with their feet. Just imagine if the families of Winterbourne View’s residents could have taken them out as easily as they could sign out of a hotel. It wouldn’t be a case of ‘tightening procedures’, as officials tend to say on these occasions — its last guests would have left last week and its gates would be chained shut.
This article first appeared in the print edition of The Spectator magazine, dated June 11, 2011